A Randomized, Placebo-Controlled, Double-Blind Study of the Effects of Magnesium Compared to Conventional Therapy on Acute Migraine

ClinicalTrials.gov processed this data on October 2, 2024. Link to the current ClinicalTrials.gov record.

Recruitment Status

COMPLETED - HAS RESULTS
(See Contacts and Locations)
Verified September 2024 by Wake Forest University Health Sciences

Sponsor

Wake Forest University Health Sciences

Information Provided by (Responsible Party)

Wake Forest University Health Sciences

Clinicaltrials.gov Identifier

NCT05967442
Other Study ID Numbers: AHC-7192-D5000322
First Submitted: January 9, 2020
First Posted: August 1, 2023
Results First Posted: October 1, 2024
Last Update Posted: October 8, 2024
Last Verified: September 2024
History of Changes

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Tracking Information
First Submitted DateJanuary 9, 2020
First Posted DateAugust 1, 2023
Results First Submitted DateJanuary 31, 2024
Results First Posted DateOctober 1, 2024
Last Update Posted DateOctober 8, 2024
Study Start DateAugust 23, 2019
Actual Primary Completion DateMarch 31, 2020
Current Primary Outcome Measures
(submitted: October 2, 2024)
  1. 30 Minute Pain Score [30 minutes after initiation]
    Scores range from 0-10. A higher score, denotes more pain
Change HistoryComplete list of historical versions of study NCT05967442 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures
  1. Length of Stay [From time of arrival to time of discharge.]
    Emergency Department Length of stay. Measured from time of arrival to time of discharged documented in the electronic medical record.
  2. Need for Rescue Analgesia [From time of arrival to time of discharge.]
    Percentage of participants who had necessity for rescue analgesics after study drug administration
Current Other Outcome MeasuresNot Provided
Descriptive Information
Brief TitleMagnesium Versus Prochlorperazine Versus Metoclopramide for Migraines
Official TitleA Randomized, Placebo-Controlled, Double-Blind Study of the Effects of Magnesium Compared to Conventional Therapy on Acute Migraine
Brief SummaryThis investigation describes a proposed clinical trial that will evaluate the relative efficacy of intravenous magnesium sulfate for the treatment of migraine compared to intravenous metoclopramide (Reglan) and intravenous prochlorperazine (Compazine) in the treatment of acute headache and migraine in adult patients. The ultimate objective will be clinical application of these drugs in the emergency department for the treatment of acute headache and migraine.

The two phenothiazines (metoclopramide and prochlorperazine) have been routinely utilized in the treatment of acute headache and migraine in the emergency department setting. Per the 2017 American Headache Society guidelines, both intravenous metoclopramide and intravenous procholorperazine are recommended as "clinicians should offer" agents with level B evidence. Of note, there are no agents with level A evidence purported by this guideline for acute management of migraine. The same guideline offers "no recommendation can be made regarding the role of intravenous magnesium for adults who present to the ED with acute migraine. However intravenous magnesium may be of benefit to patients who present with migraine with aura." Multiple trials have evaluated intravenous magnesium's safety and efficacy in the management of acute migraine. These have demonstrated the tolerability of intravenous magnesium on a with breadth of patients. Most commonly the primary adverse event was flushing which self-resolved. No cases of hypotension were reported.

None of these study agents have been withdrawn from the market.
Detailed DescriptionMigraine or severe headache affected one-fifth of women and one-tenth of men in 2015 and is one of the leading causes of disability in the world. Over one million visits to emergency departments (ED) in the US are due to migraines. Migraine, previously believed to be a vascular disorder, is caused by inflammation due to vasodilation in the meninges secondary to the release of vasoactive neuropeptides by stimulation of the trigeminal nerve. This inflammation can result in symptoms such as headache, nausea, vomiting, dizziness, photophobia and phonophobia.

Despite migraine being a common disorder, there has yet to be a cure. Several classes of medications have been studied for the treatment of migraine. Recently, conventional therapy has shifted to the use of antidopaminergics including prochlorperazine, metoclopramide and haloperidol, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, and triptans, sumatriptan being the most commonly utilized. 5Although intravenous opioids have historically been the most common treatment for migraines, their use has fallen out of favor due to their association with increased recurrence of headaches and ED visits, abuse potential, and most recently severe intravenous opiate shortage. Alternative treatments include ketamine, propofol, dihydroergotamine and magnesium.

Magnesium is an intracellular cation that has been associated with both the function of serotonin and regulation of vascular tone, which are both mechanisms that implicate its role in the treatment of migraine. Intravenous magnesium sulfate has been studied as a treatment for migraine compared to placebo, metoclopramide and prochlorperazine. These studies have shown that magnesium is well-tolerated with a good safety profile and may be efficacious in the treatment of migraine. Metoclopramide, prochlorperazine and magnesium have been recommended in clinical practice guidelines and have become routine standard of care for treatment of migraine in this emergency department. However, no trial has evaluated these modalities simultaneously in the same population. The purpose of our study is to compare the relative efficacy for magnesium, metoclopramide, and prochlorperazine in the treatment of headache and migraine.

Via monthly block randomization, patients will be given one of three guideline recommended study drugs. Allocation will be concealed by a pharmacist (not participating in the rest of the study) solely designated to choose which drug will be the assigned study drug for each month. The pharmacists, physicians, and nurses participating in administration of the medications will be blinded to which drug is being administered during each month. Metoclopramide, prochlorperazine and magnesium have been recommended in clinical practice guidelines and have become routine standard of care for treatment of migraine in this emergency department. All three study drugs will be stored in the investigational medication refrigerator located in the main pharmacy. A pharmacist on duty in the emergency department will obtain the medication from the refrigerator and deliver it to the bedside nurse who is actively caring for the patient after an order from the physician.

The primary outcome of this study will be mean change in pain from baseline to 30 minutes after initiation of infusion (as defined on a 11-point Numeric Rating Scale. Secondary endpoints include mean change in pain from baseline to 60 minutes and 120 minutes after initiation of infusion (as defined on a 11-point Numeric Rating Scale), time to emergency department discharge, and adverse effects due to administration of study drug (hypotension, flushing, akathisia, dystonia, nausea, vomiting, dizziness, drowsiness, other self-reported adverse effects).
Study TypeInterventional
Study PhasePhase 3
Study DesignAllocation: Randomized
Interventional Model: Parallel Assignment
Masking: Quadruple
Primary Purpose: Treatment
Target Follow-Up DurationNot Provided
BiospecimenNot Provided
Sampling MethodNot Provided
Study PopulationNot Provided
Condition
  • Migraine
  • Headache
Intervention

Drug: Magnesium Sulfate

Magnesium Sulfate 2gm in 50ml D5W over 20 minutes

Study Groups/Cohorts

Experimental: Magnesium
Magnesium Sulfate 2gm in 50ml D5W over 20 minutes

Intervention:
  • Drug: Magnesium Sulfate

Active Comparator: Metoclopramide
Metoclopramide 10mg in 50ml D5W over 20 minutes

Intervention:
  • Drug: Metoclopramide 10mg

Active Comparator: Prochlorperazine
Prochlorperazine in 50ml D5W over 20 minutes

Intervention:
  • Drug: Prochlorperazine (Compazine) Injection
Publications *Not Provided
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment StatusCompleted
Actual Enrollment
(submitted: October 2, 2024)
157
Actual Study Completion DateApril 6, 2023
Actual Primary Study Completion DateMarch 31, 2020
Eligibility Criteria

Inclusion Criteria:

  • Age > 18 years or older
  • Able to provide informed consent
  • Primary diagnosis of headache or migraine
  • Between October 1, 2018 to April 1, 2020
  • Presenting to Advocate Christ Medical Center emergency department and meet clinical assessment per physician

Exclusion Criteria:

  • Pregnancy defined as a positive urine HCG
  • Stated history of renal impairment
  • Allergy or sensitivity to any study drugs
  • Concomitant treatment at the time of study drug administered in the emergency department
  • Patients with a history of this study participation

Sex/GenderSexes Eligible for Study: All
Ages18 Years and Older (Adult, Older Adult)
Accepts Healthy VolunteersYes
ContactsContact information is only displayed when the study is recruiting subjects
Listed Location CountriesUnited States
Administrative Information
NCT NumberNCT05967442
Other Study ID NumbersAHC-7192-D5000322
Has Data Monitoring CommitteeNo
U.S FDA-regulated Product

Studies a U.S. FDA-regulated Drug Product: Yes

Studies a U.S. FDA-regulated Device Product: No

Product Manufactured in and Exported from the U.S.: Not Provided

IPD Sharing StatementPlan to Share IPD: No
Responsible PartyWake Forest University Health Sciences, Wake Forest University Health Sciences
Study SponsorWake Forest University Health Sciences
CollaboratorsNot Provided
InvestigatorsPrincipal Investigator: Michael Cirone, MD, advocate christ medical center
PRS AccountWake Forest University Health Sciences
Verification DateSeptember 2024